Provider Demographics
NPI:1821183666
Name:DF ROBERSON & WJ STAPLETON DDS, LTD
Entity Type:Organization
Organization Name:DF ROBERSON & WJ STAPLETON DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-259-5200
Mailing Address - Street 1:1075 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-1867
Mailing Address - Country:US
Mailing Address - Phone:618-259-5200
Mailing Address - Fax:618-259-3181
Practice Address - Street 1:1075 HARRISON ST
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1867
Practice Address - Country:US
Practice Address - Phone:618-259-5200
Practice Address - Fax:618-259-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190125511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty